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Help with Nursing Diagnosis - Pneumonia/Bronchitis & Diarrhea?

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by clee23 clee23 (New) New

So I have a patient with pneumonia/bronchitis who also have diarrhea when they came into the ER, but their diarrhea stopped. The patient have wheezes and have difficulty breathing. All lab values are normal except WBC is a little elevated, chloride level is a little elevated also, and HCT/HGB is a little low, but their oxygen saturation is normal at 95% room air. All vital signs are normal. The patient's room do smell a little like how a C. Diff pt's room will smell like, the patient did have a hem occult test and other test related to their stool, but the result didn't came back while I was in clinical. So my instructor suggest me to get a nursing diagnosis r/t to the diarrhea (which they no longer have it) and the stool testing.

The nursing diagnosis I have already are Ineffective Airway Clearance and Ineffective Breathing Pattern, I need another one that is not similar to the one I have already.

Risk for fluid and electrolyte imbalance r/t fecal incontinence a.m.b. *insert amount/#* of watery stools in X hours and limited oral intake of fluids/food.

Or something like that...hope that helps?

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

diarrhea can cause dehydration, right? but how......output greater than intake? insensible water loss that is difficult to keep up with? is there an infectious process and does the stool need to be sent to culture. excessive diarrhea can lead to fluid and electrolyte imbalances, right. so....you would have an electrolyte imbalance r/t diarrhea aeb ..........

nanda describes diarrhea as.....

nanda-i definition: passage of loose, unformed stools

diarrhea may result from a variety of factors, including intestinal absorption disorders, increased secretion of fluid by the intestinal mucosa, and hypermotility of the intestine. problems associated with diarrhea, which may be acute or chronic, include fluid and electrolyte imbalance and altered skin integrity. diarrhea may result from infectious (i.e., viral, bacterial, or parasitic) processes; inflammatory bowel diseases (e.g., crohn's disease); drug therapies (e.g., antibiotics); increased osmotic loads (e.g., tube feedings); radiation; or increased intestinal motility such as with irritable bowel disease. treatment is based on addressing the cause of the diarrhea, replacing fluids and electrolytes, providing nutrition (if diarrhea is prolonged and/or severe), and maintaining skin integrity.

common related factors

anxiety

side effects of medication use

gastrointestinal disorders

motor disorders: irritable bowel

mucosal inflammation: crohn's disease or ulcerative colitis

malabsorption

increased secretion

enteric infections: viral, bacterial, or parasitic

assess for abdominal pain, cramping, frequency, urgency, loose or liquid stools, and hyperactive bowel sensations. these are findings associated with diarrhea.

culture stool. testing will identify causative organisms.

assess hydration status, as in the following:

input and output....diarrhea can lead to profound dehydration.

skin turgor....decreased skin turgor and tenting of the skin occur in dehydration.

moisture of mucous membranes....dehydration causes dry mucous membranes.

assess condition of perianal skin. diarrheal stools may be highly corrosive as a result of increased enzyme content.

give antidiarrheal drugs as ordered. most antidiarrheal drugs suppress gastrointestinal motility, thus allowing for more fluid absorption. supplements of beneficial bacteria ("probiotics") or yogurt may reduce symptoms.

provide the following dietary alterations: bulk fiber (e.g., cereal, grains, metamucil)bulking agents and dietary fibers absorb fluid from the stool and help thicken the stool.

"natural" bulking agents (e.g., rice, apples, matzos, cheese)

avoidance of stimulants (e.g., caffeine, carbonated beverages)

stimulants may increase gastrointestinal motility and worsen diarrhea

encourage fluids to 1.5 to 2 l/24 hr plus 200 ml for each loose stool in adults unless contraindicated; consider nutritional support.

fluids compensate for malabsorption and loss of nutrients.

for patients with diarrhea from intestinal infection, anticipate the need for contact precautions.

contact precautions are necessary to prevent the transmission of microorganisms to others.

deficient fluid volume

nanda-i definition: decreased intravascular, interstitial, and/or intracellular fluid. this refers to dehydration, water loss alone without change in sodium

fluid volume deficit, or hypokalemia, occurs from a loss of body fluid or the shift of fluids into the third space, or from a reduced fluid intake. common sources for fluid loss are the gastrointestinal tract, polyuria, and increased perspiration. fluid volume deficit may be an acute or chronic condition managed in the hospital, outpatient center, or home setting. the therapeutic goal is to treat the underlying disorder and return the extracellular fluid compartment to normal. treatment consists of restoring fluid volume and correcting any electrolyte imbalances. early recognition and treatment are paramount to prevent potentially life-threatening hypovolemic shock

common related factorsinadequate fluid intake

active fluid loss (diuresis, abnormal drainage or bleeding, diarrhea)

failure of regulatory mechanisms

electrolyte and acid-base imbalances

increased metabolic rate (fever)

defining characteristicsdecreased urine output (less than 30 ml/hr)

concentrated urine

output greater than intake

hemoconcentration

increased serum sodium

hypotension/orthostasis

thirst

tachycardia/weak, rapid heart rate

decreased skin turgor

dry mucous membranes

weakness

therapeutic interventionsencourage the patient to drink prescribed fluid amounts:

  • place fluids at bedside within easy reach.
  • provide fresh water and a straw.
  • be creative in selecting fluid sources (e.g., flavored gelatin, frozen juice bars, sports drink).
  • provide oral hydrating solutions (e.g., rehydralyte).

oral fluid replacement is indicated for mild fluid deficit and is a cost-effective method for replacement treatment. older patients have a decreased sense of thirst and may need ongoing reminders to drink.

administer parenteral fluids as ordered. anticipate the need for an iv fluid challenge with immediate infusion of fluids for patients with abnormal vital signs. fluids are needed to maintain hydration states. determination of the type and amount of fluid to be replaced and infusion rates will vary depending on clinical status

institute measures to control excessive electrolyte loss (e.g., resting the gastrointestinal tract, administering antipyretics, as ordered). for hypovolemia due to severe diarrhea or vomiting, administer anti diarrhea or antiemetic medications as prescribed, in addition to iv fluids.

fluid losses from diarrhea should be concomitantly treated with anti diarrhea medications, as indicated. antipyretics can reduce fever and associated fluid losses from diaphoresis.

once ongoing fluid losses have stopped, begin to advance the diet in volume and composition. addition of fluid-rich foods can enhance continued interest in eating.

gulanick: nursing care plans, 7th edition

i hope this helps....

nursing resources - care plans

nursing care plans, care maps and nursing diagnosis

http://www.delmarlearning.com/compan.../apps/appa.pdf

cns: problem oriented nursing care plans

is there any chance that his or her (not "their," since there is only one person) diarrhea could have been caused by use or misuse of medications for the respiratory condition? look up the meds and see if any of them have that as a side effect, then ask your patient to describe proper dosing and frequency. some syrups are in a sorbitol base, which will make for diarrhea; there are others.

you could also look at nursing diagnoses relating to comfort, skin protection, and safety (if this person isn't really perfectly fine with walking/independent toileting).

Thank you guys for the help.

But in respond to those of you who suggested risk for electrolyte imbalance or related dehydration nursing diagnosis, I didn't put that as my nursing diagnosis, because my patient already stopp having diarrhea, he/she (I don't want to state if it's a female or male) wouldn't be in risk for it, because his/her intake/outtake for the last 24 hours while they was in the hospital was normal and stable. But I appreciate it!